Intervantions on non-compliant patients.
write a literature review on my client . Here is brief history that might be helpful to you.
J is a 4 year old Hispanic female diagnosed with a history of CKD stage 5 due to dysplastic kidneys. She has undergone a right laparoscopic nephrectomy and vesicostomy and left heminephrectomy & vesicostomy closure. She also has a history of a posterior soft cleft palate s/p repair and FTT. Due to her renal failure a PD catheter was placed placement and she has required daily peritoneal dialysis since 8/18/2012. She was last seen in renal clinic on 9/27/2012. She was last admitted to the hospital for 24 hours from 9/25-9/26 for a UTI. She has finished her course of antibiotics. Per MD report, her creatinine had increased from baseline ~5 to 7.16 at admission. She appears to be doing well since discharge. During the self-exam Jasmine reported some abdominal discomfort. Mother also reported that when Jasmine is active around the home she also has complaints of pain.
SWI and medical resident met with mother at length. Pacific nterpreter services was used throughout meeting. During the conversation it was brought to our attention that mother has not been giving pt’s medications as prescribed. Two weeks ago Dr. P prescribed Renvela to be given prior to each meal but the mother misunderstood and was giving the medication after meals. She claimed that she asked pt’s pediatrician about intake of medication and she also said to take after each meal. This discrepancy was discussed with pt’s pediatrician. A second dosage for another medication was increased which mother also has not been giving as directed. SWI and MD provided education about the importance of pt’s medications and how it is necessary to follow the instructions from the doctor. Mother verbalized her understanding, however, it is unclear to the team if mother processed this information appropriately and will make the changes in medications as directed. The team will continue to assess mother’s ability to comply with meds.
SWI then met with mother alone and further explored the family social situation. Mother began crying as she talked about the pressures of coping with caring for her husband who has a recently amputated leg, Jasmine’s medical condition, and caring for her 3 children . She expressed feeling very tired and reports that she does not have any social support, as all of her relatives are also busy with their own families. Mother did identify Church as a social support, however, the parents do not like to disclose their personal matters with their church. SWI provided further education about the need to comply with medications and mother began crying further. She appears overwhelmed with all of the current pressures in the home. AIDitionally she inquired about the immigration letter that had previously been discussed with Dr. . SWI then collaborated with MD and Dr. provided mother with letter at the end of the appointment.
SWI started to explore ways that the team could assist the mother with increasing her compliance or understanding of pt’s needs. Mother would benefit from ongoing education about pt’s meds and changes to doses.
Here is some ideas for the articles:
Non-complaint parents
Interventions for non -complaint parents with depression
It’s up to you but it has to be connected to the case
I will also will attach the outline for the lit.review .
If you will have any questions please feel free contact me.
Thanks Lisa
SWI and Nephrology social worker will meet with patient and family during future visits as appropriate. Will continue to collaborate with MD about case.
SWI discussed the visit with supervisor Blair Butler. We explored several options for intervention including Visiting Nurse and verifying whether pt’s medications are written on the bottles in Spanish. If meds are not currently dispensed in Spanish pt’s pharmacy will be contacted to make this change. Another pharmacy will be used if pt’s current pharmacy is not able to assist with this request. SWI will contact mother with the assistance of interpreter services to discuss these options. Will continue to closely follow.

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